17 Claims Adjuster jobs in South Africa

Main job function
Engineering & Liability claims negotiator

The duties of this position include but shall not be limited to the following:

Operational:
1. Attending to own damage claims, liability and SASRIA claims (amongst others) in respect of Plant All Risk, Contractors All Risk, Machinery Breakdown & Business Interruption and Electronic Equipment (where applicable);
2. Actively manage and oversee start to end of claims function.
3. Contribute to the growth and profitability of the Company by providing excellent service and maintaining relationships.
4. Manage and organize day to day operations by establishing priorities to ensure registering, handling and settling of claims on Company’s delegated authority and at the same time maintain the standards of the claims department.
5. Controlling of registers, compliance with SLA’s, diary management, quantum, recoveries, salvage and secure proper claims maintenance.
6. Assess the claims internally.
7. Ensure all technical aspects for claims settlement are adhered to.
8. Negotiate settlement of the claims with all relevant stakeholders.
9. Daily diary files to be extracted and dealt with e.g. letters of demand, final notices reminders and follow-up assessors’ reports.
10. Processing payments on system:
a. Registering claims with the reinsurers/co insurers companies.
b. Facultative reinsurance & co-insurance recoveries.
c. Monitor and periodically review estimates.
d. Appointment of investigators, assessors, loss adjusters and other experts if necessary.
11. Negotiate discounts to reduce costs with repairers, service providers and partners, without compromising quality or harming client retention initiatives.
12. Attend to Third party claims in terms of the Contractors Third Party Liability cover.
13. Signing off third-party releases; and
14. Third Party recoveries.

Relationship Management:
1. Liaising in a professional manner with brokers and other insurers in respect of claims aspects:
a. Following up on regular intervals and providing constructive feedback to brokers and management.
b. respond to queries within 24 hours.
2. Work with different people internally and externally to improve service, efficiency, and improve presentation of information.
3. Actively build, improve and maintain relationships with all stakeholders, i.e. internally and externally

A Consultant will be in touch if you are shortlisted for the position. Please consider your application unsuccessful should you not have been contacted within 2 weeks. We will keep your CV on our database and contact you should you match the criteria of any other vacancies.

Manage the Benefits Investigation and claims processing function, ensuring the provision of professional support services to the surviving dependents/beneficiaries (for informed allocation of benefits) to the correct beneficiaries in compliance with the Fund rules, Section 37C of the Pension Funds Act and related Acts. Ensure the timeous and accurate payment of benefits, manage issues associated with claims and benefit administration.

Manage internal departmental functions and processes

• Develop and implement plans for the section that support Pension Administration and the company's objectives, ensuring optimisation of current business and workflow processes.
• All benefit processing activities in accordance with the benefits as defined in the rules of the Fund and applicable legislation.
• Unclaimed benefits and Evidence of Survival reviews, tracing and verification.
• Fund valuation and all audits.
• Provide interpretation advice on the application of the Rules of Fund.
• Ensure that audit controls are in place and audit requests are followed up.
• Participate on the defined Committees (Benefits Committee (BC), Medical Panel (MP), Management Benefits Committee (MBC)) and take decisions based on formal documentation.

Project Management

• Participate in the Fund’s overall projects as required with continuous focus on Business Processes, system enhancements, omni channel business insight, contributing expertise to enable project objectives to be met.
• Draft reports as part of the project deliverables.

Provide input to the strategic management of the section

• Contribute ideas for improved service delivery at Management meetings.
• Compile comprehensive business reports for this function, highlighting successes and risks in terms of achieving the section’s objectives.
• Keep abreast with changes in relevant guidelines and other legislation, to make recommendations where policies and procedures need to be amended.

Oversee Section 37C dependency investigations on death benefits allocations

• Manage investigations on death benefit cases confirming dependency with recommended benefits allocation percentages for approval by Benefits Committee.
• Monitor that outstanding banking details for payment of approved death benefits are followed up, and confirmed.
• Verify that death benefits allocation reports produced are legally compliant with recommendations and reflect minimal errors.

Oversee the provision of social services to guardian cases; implementation of Benefits Committee & Medical Panel decisions and requests / referrals for case investigations and social advice from other internal departments

• Implementation of decisions, requests and referred cases, with reports and recommendations being submitted to BC, MP& BP or other internal departments.
• Ensure compliance with Fund rules and legislation to suspension, addition, termination and reinstatement of beneficiaries (widows and minor children) in compliance.

Financial Management

• Forecast annual capital and operational expenses for the section in line with corporate policy.
• Manage costs against approved budget.
• Investigate methods to contain / reduce costs.

Corporate Governance

• Ensure compliance to procedures and relevant legislation.
• Provide detailed, accurate information for internal and external audit purposes within specified deadlines.
• Action audit issues identified within time frames indicated.
• Implement controls within the section which minimize potential risk to stakeholders.

REQUIRED MINIMUM WORK EXPERIENCE AND QUALIFICATIONS

• Relevant Bachelor’s Degree, preferably in Law. Registered with professional bodies - where applicable.
• At least 6 years job-related experience, which should include at least 2 years’ experience in a management role.
• Knowledge of an African Language is an advantage.
• Working knowledge of Pension Fund Rules.
• Basic knowledge of Income Tax Act, Divorce Act, Pension Funds Act, Child Care Act, Marriage Act, Recognition of Customary Marriage Act, Mental Health Act.
• Working knowledge of Benefit administration.
• Knowledge of Law - Section 37 (C) allocation of death benefit lump sums.
• Valid driver’s license.

Should you meet the above requirements, please upload your CV to our website CVs VIA EMAIL WILL NOT BE CONSIDERED.

All suitably qualified candidates are encouraged to apply and will be considered. Our client applies the principles of employment equity as per National legislation and policy guidelines and will consider designated groups in line with these requirements.

Full spec to be shared with shortlisted candidates. Shortlisted candidates will be required to go through background screening and assessments.

R 95000 - R 12000 - Annually

• HR Services, Recruitment & Selection

Senior Short Term Insurance Claims Handler with minimum 3 years’ Personal Lines and Commercial Claims experience in senior capacity and with the required NQF4 and RE5 Certifications, required to join this Broker Firm based in Bellville, Cape Town.

Minimum requirements:

• Matric essential
• NQF4 Short Term Insurance minimum
• RE5 essential
• Minimum 3 years’ claims handling experience in Personal Lines and Commercial Insurance in a senior role required
• Flexi, Cardinal and or CIMS 360 preferred

Duties and Responsibilities:

• Oversee negotiation and settlement of claims across Personal & Commercial lines
• Claims registration
• Claims management
• Negotiate settlements
• Communication with all stakeholders
• Complaints
• Evaluate and improve claims processes

About the Company:

Pacific International Insurance is a licensed general insurance provider, offering reliable coverage for policyholders across Australia and New Zealand. Our diverse range of personal and business insurance solutions includes motor vehicle, pet, mobility equipment, professional indemnity, and general liability insurance.

About the Product:

PD Insurance AU offers award-winning, affordable, and high-value pet and car insurance coverage.

The Opportunity:

Are you a customer-focused, energetic, and passionate individual? We are on the hunt for a Claims Consultant to join our vibrant call centre team in George. This is your chance to make a real impact and be part of a dynamic team!

What’s the overall purpose of this position?

In exchange, we will provide you with a fun and collaborative team environment, a supportive management system and the motivation to reach your full potential! ?

Some of the benefits:

• Competitive basic monthly salary with company benefits and contributions.
• Employee loyalty and long service rewards.
• Professional company branded gear.
• Health benefits: exciting offers from our Lifestyle department to keep you fit and healthy!
• On-site coffee shop and restaurant dedicated to our employees.
• Training and development: all newbies undergo a training programme to equip you with the knowledge and tools to thrive in your role.
• Working hours that provide you with more flexibility during the day.
• Company transport available to the office.

Working hours:

• Mondays to Fridays: 03h30 – 11h00 AM OR 00h00 – 07h30 AM (2 rotational shifts)

These working hours accommodates our clients and colleagues in Australia and New Zealand. Providing you with more flexibility during your day!




We would love to receive your application if you meet the following requirements:

• Completed Grade 12 / National Senior Certificate.
• Excellent written and verbal communication skills in English. You will need a clear English accent and be able to understand the whacky Aussie and New Zealand accents!
• Intermediate level computer skills.
• Prior experience in a customer service orientated position.
• Strong attention to detail, organisational and administration skills.
• Willing to work “night-shift” hours (to accommodate the Australian and New Zealand operating hours of clients and colleagues).
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Other skills that would be advantageous:

• Previous experience handling insurance claims or working in a financial services institution.
• Skills in negotiation, persuasion and investigation with customers and service providers.
• Sound interpersonal skills, building rapport with customers and service providers.
• Skilled in asking probing questions and gaining detailed information to support claims handling.

• Make and receive calls to clients
• Gather and follow up all info and documents required to register claims
• Advise on claims under what section covered on policies
• Interact and follow up with Insurers
• Involvement with claims intermediary service (Client satisfaction)
• Follow claims through to Agreement of Loss and signed by client
• Use logic and intellect to ensure customers are treated fairly
• Build trust-based relationships with clients

Key Skills and Competencies:

• Good verbal and written communication skills at all levels
• Computer literate in Microsoft Office and internet
• Self-discipline and time management
• Punctuality

Candidates must have the following qualifications:

• Grade 12

Competence:

• Experience (1+ Years in industry)
• Class of Business completed for STI Personal and Commercial lines
• Operational Ability
• Product Specific Training

The following additional factors will be to your (Candidates) advantage:

• Experience on SANTAM online system
• Product specific training completed with main players in insurance industry: Santam, Old Mutual, Momentum (Previously Alexander Forbes), Bryte et

Main characteristics / strong points for candidates:

• Good verbal- and written communication skills at all levels
• Computer literate in Microsoft office and internet
• Self-discipline and time management
• Punctuality
• Make and receive calls to clients
• Gathering and follow up all info and documents required to register claim.
• Advise on claims under what section covered on policies.
• Interaction and follow up with Insurers
• Involvement with claims intermediary service (Client satisfied).
• Follow claim through to Agreement of Loss and signed by client.
• Logic and intellect to ensure customers treated fairly.
• Build relationships (Trust) with clients

Claims Administration
Administer complete claims process according to defined claims procedures until claims are settled.
Apply policy terms and conditions.
Make assessment of claims validity and estimate value and administer mandated claims.
Act as intermediary between insurer and client and timeously relay communication, requests and documentation.
Engage with insurers regarding recoveries, diarise follow-ups and keep clients informed.
Ensure productivity targets are met.
Contribute towards and ensure continuous improvement in own and team performance.
Adhere to company mandates.
Participate and contribute in ad hoc projects.
Report any suspected fraud, misrepresentation and/or dishonesty.
Keep accurate record of own activities.

RE 5 A MUST

MATRIC A MUST

CREDITS WOULD BE GREAT

Salary: R20 000 - R25 000

• HR Services, Recruitment & Selection

Claims Administration
Administer complete claims process according to defined claims procedures until claims are settled.
Apply policy terms and conditions.
Make assessment of claims validity and estimate value and administer mandated claims.
Act as intermediary between insurer and client and timeously relay communication, requests and documentation.
Engage with insurers regarding recoveries, diarise follow-ups and keep clients informed.
Ensure productivity targets are met.
Contribute towards and ensure continuous improvement in own and team performance.
Adhere to company mandates.
Participate and contribute in ad hoc projects.
Report any suspected fraud, misrepresentation and/or dishonesty.
Keep accurate record of own activities.

RE 5 A MUST

MATRIC A MUST

CREDITS WOULD BE GREAT

Salary: R20 000 - R25 000

• HR Services, Recruitment & Selection